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What underlies the high alcohol related mortality of the disadvantaged: high morbidity or poor survival?
  1. P Mäkelä1,
  2. I Keskimäki1,
  3. S Koskinen2
  1. 1STAKES, National Research and Development Centre for Welfare and Health, Finland
  2. 2KTL, National Public Health Institute, Finland
  1. Correspondence to:
 P Mäkelä
 STAKES, PO Box 220, 00531 Helsinki, Finland;


Study objective: To investigate whether the large socioeconomic differences in alcohol related mortality can be explained by differences in morbidity or differences in survival.

Design: Register linkage study. A nationwide hospital discharge register was linked to population censuses for socioeconomic data and to the cause of death register for mortality follow up.

Setting: Finland.

Participants: Men and women aged 15 years and older discharged from hospitals with an alcohol related diagnosis in 1991–1996.

Measurements: Mortality hazard up to the end of 1997 by socioeconomic category was estimated with Cox’s regression model.

Main results: Socioeconomic differences in alcohol related hospitalisation rates were almost as large as those that have been observed for alcohol related mortality. For example, the rate ratio among male unspecialised workers for any alcohol related hospitalisations was 3.6 as compared with upper white collar workers; among women the rate ratio was 2.7. Depending on gender, age, hospitalisation diagnosis, and cause of death, survival after discharge either showed no socioeconomic differences or it was worse among better off groups.

Conclusions: The study suggests that differences in survival after hospitalisation do not cause the high socioeconomic differences in alcohol related mortality.

  • Keywords: alcohol
  • hospital discharge
  • mortality
  • socioeconomic status
  • survival

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